EVERY time a new public-health intervention arrives in Pakistan, a familiar accusation surfaces: it will somehow harm our fertility.
From the polio vaccination drives of the 1990s to the COVID-19 vaccines during the pandemic and now to the Human Papillomavirus (HPV) vaccine, the refrain is strikingly similar.
Rumours spread on social media and in drawing-room discussions that “international agendas” are being forced on us and that countries such as the United States and Israel are “jealous” of Pakistan’s supposed boundless fertility. Yet the numbers tell a different story. According to the 2023 census, Pakistan’s population growth rate actually rose to 2.55% compared with 2.40% in the previous census. Far from a decline, we are adding more people every year than before. If there is a global conspiracy to reduce Pakistani fertility, it is failing spectacularly.
The contrast between the public’s intense suspicion of vaccines and its relative silence on other imported trends is striking. Fast-food chains flourish in every city, sugary drinks are consumed at unprecedented rates and our lifestyles increasingly mirror Western patterns of inactivity. Pakistan now ranks among the world’s top countries for diabetes prevalence. Yet these clear and present health risks rarely trigger the same level of outrage or conspiracy theories as vaccination programmes designed to prevent disease.
The newest target of fertility-related rumours is the HPV vaccine. Internationally, HPV vaccination is a proven tool for preventing cervical cancer—a disease responsible for thousands of female deaths each year in low- and middle-income countries. The argument often heard in Pakistan is that “our girls do not have multiple sexual partners,” so the vaccine is unnecessary. Even if that assumption were universally true, it misses a critical point: Pakistan has a large, under-acknowledged commercial sex industry. A review article on HIV transmission published a few years ago estimated that around 60 million paid sex acts occur annually in Pakistan, involving roughly three million clients.
In such a context, a woman can be entirely faithful to her husband and still be exposed to HPV if her husband has other sexual partners, paid or otherwise. This is not a marginal risk. In countries where HPV vaccination has been widely implemented, rates of cervical precancer and cancer have dropped dramatically. The vaccine works best when given before sexual debut, but even later it still offers protection. Denying Pakistani girls access to it on the basis of myths about fertility and moral assumptions about women’s behaviour does not protect families; it leaves them vulnerable to preventable disease.
Underlying these repeated controversies is a deeper problem of trust. Many citizens genuinely believe that international agencies cannot act without hidden motives, while at the same time embracing Western consumer goods and lifestyles that are clearly harming their health. This selective skepticism reflects both our colonial past and our present-day failures of public communication. When health authorities do not engage transparently, rumours flourish. When religious leaders or community elders are not included in awareness campaigns, misinformation fills the gap.
Breaking this cycle requires a different approach. Public-health campaigns need to explain, in simple and culturally sensitive terms, what a vaccine does and—crucially—what it does not do. Independent local experts, not just international agencies, should be the faces of these programmes. And the conversation must shift from “Western plot” narratives to an honest reckoning with our real health crisis: uncontrolled population growth combined with rising rates of non-communicable diseases and high-risk sexual behaviour.
Pakistanis pride themselves on their family values. Protecting the health of mothers and daughters is part of that duty. Vaccines like HPV do not reduce fertility; they reduce suffering and death. The sooner we move beyond conspiracy theories and focus on evidence, the sooner we can secure a healthier future for our children.
—The writer is Associate Professor, Health Services Academy, Islamabad.
